Not Really Sick? Doctors Warned About Bizarre Form of Child Abuse

A new report cautions doctors to be on the look out for signs of Munchausen syndrome by proxy.

Two pediatricians have drafted new guidelines they say doctors should
follow if they suspect a caregiver has fabricated or induced an illness
in a child.

Dr. Emalee G. Flaherty of the Northwestern University
Feinberg School of Medicine in Chicago and Dr. Harriet L. MacMillan of
the Michael G. DeGroote School of Medicine at McMaster University in
Canada released their recommendations today in the journal Pediatrics.

They
stressed that doctors need to make a thorough review of a child's
medical records, meticulously document everything a caregiver tells
them, and reach out to and confer with other medical professionals, as
well as child protective services and social workers when necessary.

Previously
called Munchausen syndrome by proxy, Flaherty and MacMillan believe
this disorder is more accurately classified as pediatric condition
falsification, factitious disorder by proxy, child abuse in the medical
setting, or medical child abuse.

“When
clinicians see children [they should] ask themselves, is this history
that's presented by the parent, does it really make sense, does it fit
together?” MacMillan told Healthline. “Couple that with a situation
where a child seems at risk of or is undergoing unnecessary or harmful
procedures or medical care, clinicians really need to be thinking about
what's happening here or what's really going on.”

Unexplained Physical and Mental Symptoms

Caregivers
who abuse children in this way often have kids who show symptoms of
conditions like sleep apnea, malnutrition or anorexia, attention deficit
disorder, bleeding, or seizures.

“It's
not just physical symptoms; it's also emotional symptoms,” MacMillan
said. “Sometimes a parent reports that a child is repeatedly trying to
hurt themselves and take their life when, in fact, there's no indication
that that is happening.”

The
possibility of caregiver-fabricated or caregiver-induced illness
presents a tremendous dilemma for doctors. Most physicians will not
report the incident to authorities unless they are almost completely
convinced it is true, MacMillan said.

While this syndrome is very rare, it is probably more common than doctors believe, she added.

“It's
hard for clinicians to entertain the idea that a person is purposely
doing this,” MacMillan said. “They're trained to trust the histories
that are provided to them.”

Usually, the only
way to know for certain whether a child is a victim of this kind of
abuse is to remove them from the caregiver, which is a serious step to
take, MacMillan said.

“When
people hear that, understandably they're like, 'Wow, that's potentially
very intrusive,'” MacMillan said. Still, she said placing a child with a
relative or in foster care, where they can continue their daily
activities, is better than putting them in the hospital for observation.

In
some instances, physicians may even need to consider covert video
surveillance of a hospitalized child to monitor the caregiver's actions.
This is controversial, however, and many facilities are reluctant to do
it, MacMillan said.

What to Watch For

The report suggests doctors look for these things if they suspect a child is been a victim of induced or fabricated illness:

The diagnosis does not match the objective findings.

The signs or symptoms are bizarre.

The
caregiver or suspected offender does not express relief or pleasure
when told that a child is improving or does not have an illness.

Inconsistent histories of symptoms are provided by different observers.

The caregiver insists on invasive or painful procedures and hospitalizations.

The caregiver’s behavior does not match expressed distress or the report of symptoms.

The child's sibling has had an unusual illness or death.

The caregiver publicly solicits sympathy, donations, or benefits because of the child’s illness.

What
makes a caregiver abuse a child in this way? Usually, they want an
intense relationship with the child's physician, perhaps to get positive
feedback about how much they care for their child, MacMillan said,
though there are no defined psychological problems that are common in
all offenders.

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